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1. CN109598628 - Medical insurance fraud behavior identification method, device and equipment and readable storage medium

Office Chine
Numéro de la demande 201811462221.5
Date de la demande 30.11.2018
Numéro de publication 109598628
Date de publication 09.04.2019
Type de publication A
CIB
G06Q 40/08
GPHYSIQUE
06CALCUL; COMPTAGE
QSYSTÈMES OU MÉTHODES DE TRAITEMENT DE DONNÉES, SPÉCIALEMENT ADAPTÉS À DES FINS ADMINISTRATIVES, COMMERCIALES, FINANCIÈRES, DE GESTION, DE SURVEILLANCE OU DE PRÉVISION; SYSTÈMES OU MÉTHODES SPÉCIALEMENT ADAPTÉS À DES FINS ADMINISTRATIVES, COMMERCIALES, FINANCIÈRES, DE GESTION, DE SURVEILLANCE OU DE PRÉVISION, NON PRÉVUS AILLEURS
40Finance; Assurance; Stratégies fiscales; Traitement des impôts sur les sociétés ou sur le revenu
08Assurance, p.ex. analyse des risques ou pensions
CPC
G06Q 40/08
GPHYSICS
06COMPUTING; CALCULATING; COUNTING
QDATA PROCESSING SYSTEMS OR METHODS, SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL, SUPERVISORY OR FORECASTING PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL, SUPERVISORY OR FORECASTING PURPOSES, NOT OTHERWISE PROVIDED FOR
40Finance; Insurance; Tax strategies; Processing of corporate or income taxes
08Insurance, e.g. risk analysis or pensions
Déposants PING AN MEDICAL HEALTH MANAGEMENT CO., LTD.
平安医疗健康管理股份有限公司
Inventeurs HUANG YUE
黄越
CHEN MINGDONG
陈明东
Mandataires 深圳市世纪恒程知识产权代理事务所 44287
Titre
(EN) Medical insurance fraud behavior identification method, device and equipment and readable storage medium
(ZH) 医保欺诈行为的识别方法、装置、设备及可读存储介质
Abrégé
(EN)
The invention discloses a medical insurance fraud behavior identification method, device and equipment and a readable storage medium. The method comprises the steps: reading the medication informationand treatment time of each treatment patient in a preset time interval, and enabling the treatment patients with the same medication information to form a patient set; Determining target doctor-seeing patient pairs for doctor seeing in the patient set within a preset interval time according to the doctor-seeing time, and counting the number of doctor seeing times of each target doctor-seeing patient pair; Forming a relationship network for each target doctor-seeing patient pair according to the doctor-seeing times, and judging whether the doctor-seeing times corresponding to the relationshipnetwork are greater than a preset value or not; And if the number of treatment times corresponding to the relationship network is greater than a preset value, identifying the treatment behavior of each treatment patient in the relationship network as a medical insurance fraud behavior. According to the scheme, the association relationship between the treatment time and the medication information of each treatment patient is accurately represented based on the relationship network formed by big data analysis, so that the medical insurance fraud behavior identified according to the relationshipnetwork is more accurate and effective.

(ZH)
本发明公开一种医保欺诈行为的识别方法、装置、设备及可读存储介质,所述方法包括:读取预设时间区间内各就诊患者的用药信息和就诊时间,并将具有相同用药信息的就诊患者形成患者集;根据就诊时间,确定患者集中在预设间隔时间内进行就诊的目标就诊患者对,并统计各目标就诊患者对进行就诊的就诊次数;根据就诊次数,将各目标就诊患者对形成关系网,并判断与关系网对应的就诊次数是否大于预设值;若与关系网对应的就诊次数大于预设值,则将所述关系网中各就诊患者的就诊行为识别为医保欺诈行为。本方案中基于大数据分析形成的关系网,准确表征了各就诊患者在就诊时间及用药信息之间的关联关系,使得依据关系网识别的医保欺诈行为更为准确有效。

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